Reviewed for medical accuracy by Dr. Jaggi Rao, MD, FRCPC Double board-certified dermatologist
An itchy, ugly, red pimple is an obvious symptom of acne inflammation. But acne inflammation is not necessarily caused by acne bacteria, and blemishes that are not red, itchy, tender, or painful can still be inflamed.
Article Table of Contents
Acne bacteria do not cause acne inflammation. The immune system’s response to them does.
You can fight inflammation before it even starts, and this is by keeping pores open.
Different skin types need different treatments.
The darker your skin, the more important it is both (1) to fight acne infection as soon as you see it and (2) to avoid irritating the skin in the process.
“Calming” the skin helps reduce inflammation on fair, dry, tight skin.
Hydrating the skin is useful for Asian skin.
African-American and Hispanic skin types require immediate treatment of pimples as soon as they are seen, but with gentle disinfectants.
In fact, small numbers of acne bacteria are actually beneficial to the skin3. The skin makes sebum to keep itself flexible and to keep itself from drying out. Many of the things people to do “dry out” their acne actually increase the production of sebum, swabbing the skin with rubbing alcohol, for instance. When the skin is stressed or stretched or inflamed, sebaceous glands near pores produce more sebum to protect the skin4. When the body as a whole is stressed, the brain releases corticotrophin stimulating hormone, which also triggers production of excessive sebum.
Acne bacteria feed on sebum to keep it from accumulating faster than pores can transport it to the surface, where it can be washed away. As long as the pore is filled with fresh, liquid sebum, the bacteria can feed and multiply. As sebum ages, however, it releases essential fatty acids. These are beneficial to the skin, but toxic to bacteria. The skin regulates the number of bacteria in pores, keeping the population of bacteria the right size to be helpful—until pores get clogged.
It is a common misconception that bacteria in clogged pores irritate the skin. Actually, they don’t. The immune system’s5 efforts to kill the bacteria that can’t be killed by the breaking down of sebum is what inflames pores and causes acne. The bacteria secrete chemicals that make the skin more sensitive to a substance called interleukin-8. Then when corticotrophin stimulating hormone causes the release of histamine from mast cells in the skin, the interleukin-8 attracts it to the lining of the pores. The inflammation of the pore creates an escape route for acne bacteria to get to the surface and travel to a friendlier pore.
Fighting Acne Bacteria and Acne Inflammation
The way acne bacteria are actually involved in acne inflammation tells some very important things about why traditional methods of fighting acne often backfire:
Worrying about acne bacteria also increases inflammation of the skin. And many children, teens, and adults who have persistent acne understandably worry about their appearance!
Moreover, a product that fights acne bacteria on one skin type can cause acne inflammation on another.
Asian8 and African skin types are especially sensitive to detergent cleaners. Anything that generates lots of suds containing big bubbles does remove oil and bacteria, but also injures the skin so it produces more oil that becomes food for more bacteria.
People of European descent tend to be especially sensitive to essential oils. White skin responds to stress hormones. Essential oils activate the brain. This can be a good thing in treating many conditions, but if you have fair skin, an essential oil or aromatherapy product that relaxes your brain often excites your skin. If it smells good, don’t put it on your skin!
People of Hispanic descent tend to have an all-or-nothing experience with acne. They tend either to have no acne at all, or to develop cystic acne in early adulthood. Products that stimulate the production of collagen in the skin can actually make cystic acne much worse.
Acne inflammation leads to discoloration of darker skin9. The skin fights inflammation with the pigment melanin. Darker skins have more cells that produce melanin, and they tend to overproduce melanin in their efforts to control inflammation. Acne and harsh acne treatments, as well as cuts, scrapes, bruises, and other skin infections, can cause lasting discoloration of the brown or black skin.
“Calming” the skin is especially important if you have fair, tight, or allergy-prone skin. Any easy way to do this is with water. A splash of any kind of bottled mineral water (Perrier, Pelegrino, or even Topo Chico) on to the face after you have cleansed it, but before you put on moisturizer and makeup, provides magnesium that slows down the release of stress chemicals in the skin. Certain facial waters also provide sulfur to kill bacteria and selenium to help the skin make antioxidant enzymes, but you want to be sure the facial water contains just water, not any herbs, plant essences, essential oils, or perfumes.
Hydrating the skin is especially important—although often overlooked—if you have Asian skin. It is important to avoid alcohol or detergents of any kind, since these dry out the skin. And it is important to lock in moisture with light applications of water-based or even oil-based moisturizers.
Fighting acne infection early is important for people who have Hispanic or Mediterranean skin types, and for Black men who shave their heads or shave their beards too close. These skin types11 repair injuries quickly, often trapping bacteria inside cysts. Using a gentle antiseptic such as a 2.5% (or milder) concentration of benzoyl peroxide at the very first sign of a pimple is important in these skin types. But it is also important to avoid treatments that sting or burn the skin, since they can cause discoloration.
Some skin types can’t stand peels, but they respond well to lemon juice, fresh-squeezed rather than from a bottle. The lemon juice breaks down oils on the skin, letting acne bacteria escape, reducing the need for inflammation to fight infection.
Does all this get a little too complicated? The easiest way to treat acne inflammation is to use a complete skin care system like Exposed Skin Care.
Farrar MD, Ingham E. Acne: inflammation. Clin Dermatol. 2004 Sep-Oct;22(5):380-4.
Antiga E, Verdelli A, Bonciani D, Bonciolini V, Caproni M, Fabbri P.Acne: a new model of immune-mediated chronic inflammatory skin disease. G Ital Dermatol Venereol. 2015 Apr;150(2):247-54.
Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. 2011 Jan-Mar;3(1):41-9.
Tanghetti EA. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol. 2013 Sep;6(9):27-35.
Gollnick HP, Zouboulis CC. Not all acne is acne vulgaris. Dtsch Arztebl Int. 2014 Apr;111(17):301-12.
Chen YE, Fischbach MA, Belkaid Y. Skin microbiota-host interactions. Nature. 2018 Jan 24;553(7689):427-436.
Goh CL, Noppakun N, Micali G, Azizan NZ, Boonchai W, Chan Y, Cheong WK, Chiu PC, Etnawati K, Gulmatico-Flores Z, Foong H, Kubba R, Paz-Lao P, Lee YY, Loo S, Modi F, Nguyen TH, Pham TL, Shih YH, Sitohang IB, Wong SN. Meeting the Challenges of Acne Treatment in Asian Patients: A Review of the Role of Dermocosmetics as Adjunctive Therapy. J Cutan Aesthet Surg. 2016 Apr-Jun;9(2):85-92.
Adalatkhah H, Sadeghi Bazargani H. The association between melasma and postinﬂammatory hyperpigmentation in acne patients. Iran Red Crescent Med J. 2013 May;15(5):400-3.
How to treat deep, painful pimples | American Academy of Dermatology. Aad.org. 2019.
Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol. 2010 Apr;3(4):24-38.